The Relationships Between Length, Width and Type in Clefts of the Palate

Purpose: It has been proposed that the greater the severity of the cleft of the palate, the worse the outcome(1-3). The primary objective of this study is to determine the relationship between cleft palate length, cleft palate width and cleft type.

Methods: A review of prospectively collected data on all consecutive primary palate repairs by a single surgeon, from January 2000 to January 2010, was completed. Patient demographics, Veau classification (I-IV), Kernahan & Stark classification - primary/secondary palate (CL/P) & secondary palate(C/P), Randall length (I-IV) and measurement of cleft width were analyzed for associations.

Results: 485 patients underwent primary palatoplasties from January 2000 - January 2010. There were 276 males and 209 females; mean age was 20.4 months (range, 6.6 months-17.7 years). Kernahan & Stark Class included; CP= 260 and CL/P=225. Veau Class included: I=85, II= 175, III=165, IV=60. Randall length included: I=81, II=319, III=58, IV=2. Average cleft width was 7.7 mm (range, 0-19 mm). Significant associations included: CP was associated with Randall Type I (longer palates), CL/P was associated with Randall Type III (shorter palates) (p<0.0001). Randall Types II-IV had wider clefts than Randall Type I (p<0.0001). Wider clefts were seen in the CL/P group (p<0.0001). A difference in width was seen in unilateral and bilateral CL/P with p=0.0034. Conclusions: Patients with CL/P have wider palates than patients with CP, and are more often associated with Randall Types II & III. Patients with CP are more often associated with Randall Types I & II. Width and length is similar amongst unilateral and bilateral CL/P. Preoperative width and length may be used to explain the outcomes seen in varying degrees of cleft palate severity.

1. Sullivan SR, et al. Palatoplasty outcomes in nonsyndromic patients with cleft palate: a 29-year assessment of one surgeon's experience. J Craniofac Surg 2009;20:612-16. 2. Seyfer AE, Simon CD. Long-term results following the repair of palatal clefts: a comparison of three different techniques. Plast Reconstr Surg 1989;83(5):785-90; discussion 791-2. 3. Krause CJ, Tharp RF, Morris HL. A comparative study of results of the von Langenbeck and the V-Y pushback palatoplasties. Cleft Palate Craniofac J 1976;13:11-19.